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justified.* There is no other acute intestinal disease of man known in which such a condition occurs.
The rice-water stool of the woman Bailey for instance, case 1, and of several others which I have
examined, had the character just stated; so that in these cases the microscopic examination alone enabled
me to make the diagnosis of true cholera; the cultivation in peptone; the cholera-red reaction in these
cultures, after 6, 8 or 10 hours; the cultivations in gelatine plates, in Agar plates, and in stab and
streak cultures in gelatine and in Agar, fully confirmed the correctness of the provisional conclusion.
2,—The peptone culture of the stool or of the intestinal contents in all cases yielded positive results
if at the outset cholera vibrios were present. I stated in a former paragraph that there were cases in
which from the microscopic examinations alone no preliminary conclusion could be arrived at, since
amongst the crowds of bacteria present, only here and there an organism was found which in size and
shape (comma shaped) resembled Koch's vibrio; but Dunham's peptone-salt solution inoculated with
the material, yielded positive evidence, inasmuch as already after 6-12 hours copious crops of the
cholera vibrios were obtained, which in sub-cultures (gelatine, Agar, potato, milk and peptone) proved
themselves the undoubted cholera vibrios. Such, amongst others I have examined, were cases 8,4 and 12.
3.—In addition to the above tests we have the characters of the growth obtained by cultivation
in the ordinary media, to which I need not further refer.
These then were the lines on which I have hitherto based my preliminary reports as to the
result of the examination of intestines or stools submitted to me. Knowing that Koch's comma bacillus
(judging by morphological and cultural and chemical characters) does not occur in any except true
cholera cases, I have felt justified when they were shown to be present in the stool or in the intestinal
contents, in definitely pronouncing those cases as Asiatic cholera.
Whether cases in which they (the particular comma bacilli) cannot be demonstrated by the above
tests are or are not cases of true Asiatic cholera, cannot, in the present state of our knowledge, be satisfactorily
answered. It is on record that experienced observers, who have devoted special attention to this
very point, have had before them cases which, clinically and pathologically, presented the characters of
Asiatic cholera— cases which occurred in localities, and at times when true cholera was rife (in Hamburg,
in Russia, in France, and elsewhere)—but in which no Koch's comma bacilli could be demonstrated.
In conclusion, I wish to state that the comma bacilli which I have isolated from the numerous
cases of cholera that occurred in England during September and October last do not belong to one
single species, or, to speak more correctly, they rather represent varieties of a species; though, in a
general way, their morphological and cultural characters are the same, there nevertheless exist between
them certain definite and permanent differences in their mode of growth in the different media, and the
amount of cholera-red produced by them in the peptone cultures.

Yours faithfully,
(Signed) E. Klein.
*Numerous statements have appeared in the lay and medical press from which a conclusion has been
drawn that I have changed my opinions on this point. To show that such conclusion is contrary to fact, I may
be allowed to recall what I stated in my articles on cholera, that appeared in the "Practitioner" in 1886-1887,
which have been reprinted in book form.
("The Bacteria in Asiatic Cholera," Macmillan.)—On page 114 of this work, I say—"One thing, however,
may be said with certainty, namely, that as far as our limited knowledge at present goes, in no intestinal disorder
in man (except Asiatic cholera) have comma bacilli behaving in artificial cultures like those of Asiatic cholera
been yet found in the intestinal examinations."And on page 115—" Hence I agree with the proposition that if
in any case of diarrhcea the choleraic comma bacilli can be shown both by the microscope and by culture
experiments to exist, then the suspicion that it may be a case of Asiatic cholera is quite justified."
f These two cases were examined by Dr. Klein for the Medical department of the Local Government Board.